Consensus guidelines for the management of pediatric medulloblastoma in low and middle-income countries

Abstract

The management of medulloblastoma, a pediatric brain
tumor, has evolved significantly with the advent of
genomic subgrouping, yet morbidity and mortality
remain high in LMICs like Pakistan due to inadequate
multidisciplinary care infrastructure. This paper aims to
establish evidence-based guidelines tailored to the
constraints of such countries. An expert panel comprising
neuro-oncologists, neurosurgeons, radiologists, radiation
oncologists, neuropathologists, and pediatricians
collaborated to develop these guidelines, considering the
specific challenges of pediatric brain tumor care in
Pakistan. The recommendations cover various aspects of
medulloblastoma treatment, including pre-surgical
workup, neurosurgery, neuropathology, chemotherapy,
radiation therapy, and supportive care. They offer both
minimum required and additional optional protocols for
more advanced centers, ensuring comprehensive patient
management with attention to complications and
complexities encountered in Pakistan. The paper's
consensus guidelines strive for uniformity in healthcare
delivery and address significant gaps in diagnosis,
treatment, and follow-up of pediatric medulloblastoma
patients.
Keywords: Medulloblastoma, neuropathology,
neurosurgery, radiation oncologists, brain neoplasms,
paediatricians, morbidity, genomics